Assessment Of Cervical Spine Research Articles

Imaging of the cervical spine injury in elderly patients

Background: The RCR and NICE recommends developing local protocol for primary imaging modality for cervical spine (CSPN) assessment of blunt cervical injury in elderly patients (>65 yrs). Literature suggests young elderly (65 – 75yrs) are less likely to need further imaging than old elderly (>75yrs). Distinction reflects observed differences in functional decline, trauma mortality rates and osteoporosis

Physical therapy treatment in patients suffering from cervicogenic somatic tinnitus: study protocol for a randomized controlled trial.

BackgroundTinnitus occurs in a large part of the general population with prevalences ranging from 10% to 15% in an adult population. One subtype is cervicogenic somatic tinnitus, arising from cervical spine dysfunctions, justifying cervical spine assessment and treatment. This study aims to investigate the effect of a standardized physical therapy treatment, directed to the cervical spine, on tinnitus. Additionally, a second aim is to identify a subgroup within the tinnitus population that benefits from physical therapy treatment.Methods and designThis study is designed as a randomized controlled trial with delayed treatment design. Patients with severe subjective tinnitus (Tinnitus Functional Index (TFI) between 25 and 90 points), in combination with neck complaints (Neck Bournemouth Questionnaire (NBQ) >14 points) will be recruited from the University Hospital of Antwerp.Patients suffering from tinnitus with clear otological etiologies, severe depression, traumatic cervical spine injury, tumors, cervical spine surgery, or conditions in which physical therapy is contra-indicated, will be excluded.After screening for eligibility, baseline data such as TFI, NBQ, and a set of cervical biomechanical and sensorimotor tests will be collected.Patients are randomized in an immediate therapy group and in a group with a delayed start of therapy by 6 weeks.Patients will receive physical therapy with a maximum of 12 sessions of 30 min for a 6-week program. Data from the TFI and NBQ will be collected at baseline (week 0), at the start of therapy (weeks 0 or 6), at the end of therapy (weeks 6 or 12), 6 weeks after therapy (weeks 12 or 18), and 3 months after therapy (weeks 18 or 24). Secondary outcome measures will be collected at baseline and 6 weeks after the therapy (weeks 12 or 18), as the maximal therapy effect on the cervical spine dysfunctions is expected at that moment.DiscussionThis study is the first to investigate the effect of a standardized physical therapy treatment protocol on somatic tinnitus with a prospective comparative delayed design and with blinded evaluator for baseline, end of therapy, and 6 and 12 weeks after therapy.Trial registration12 September 2013, ClinicalTrials.gov: NCT02016313

AB1129 Radiological cervical spine involvement in juvenile idiopathic arthritis in adulthood

BackgroundSeveral studies have assessed cervical spine structural involvement in juvenile idiopathic arthritis (JIA) but most of them included only symptomatic patients without differentiating subsets of JIA.ObjectivesTo evaluate the frequency and...

Diagnostic work-up of an elderly patient with unilateral head and neck pain. A case report

Headache patients frequently contact physiotherapists and manual therapists. In case of elderly patients with unilateral headache, neck and facial pain clinical practice guidelines recommend further referral for medical investigation to exclude red flags. The present patient was seen in a multidisciplinary headache clinic. He was referred by the neurologist (headache specialist) for physiotherapeutic assessment after screening for red flags, including giant cell arteritis (GCA). After first assessment, GCA was considered unlikely, since the sedimentation rate, as a marker for inflammation, was only slightly elevated. The purpose of the referral was to exclude cervicogenic headache (CEH) and to explore physical treatment as a therapeutic option. Physiotherapeutic assessment consisted of a history taking on CEH signs (Sjaastad criteria, 1998), followed by cervical spine assessment including tests for neck mobility, joint pain, and endurance of the short neck flexors. The patient's history revealed no specific signs of CEH and cervical spine assessment was negative. In consultation with the neurologist, the diagnosis of CEH was abandoned. Since palpation of the temporal artery proved to be painful, laboratory examination and biopsy of the temporal artery were thereafter performed, this time revealing GCA. Appropriate treatment (high dose steroids) was initiated promptly, with a good clinical evolution. The presented case shows the potential of a multidisciplinary collaboration in the clinical diagnostic work-up of patients with head and neck pain.

Effect of tailored cervical pillow on the neck muscle strength balance of cervical spondylosis patients

Objective To study the effect of tailored cervical pillow on the neck muscle strength balance of patients with cervical spondylosis.Methods Totals of 60 cases of cervical spondylosis patients were randomly divided into experimental group and control group,with 30 cases each group,the patients of the two groups were treated with conventional treatment and nursing,while experimental group used the tailored cervical pillow for 8 hours every day and one month (1 course ). Two groups were being respectively received the isometric muscle strength and movement of the cervical spine assessment with the symptoms and functional assessment scales,clinical assessment and multifunctional cervical vertebra rehabilitation system (MCU).Results Experimental group were significantly improved than that of the control group in symptoms and functional assessment scale score[ (24.84 ± 2.341 ) vs ( 20.65 ± 2.134 ) ; t =3.024,P ＜0.05 ],The overall clinical curative effect,difference has statistical significance [ 60.0％ vs 30.0％ ; x2=5.455,P ＜ 0.05 ] ; the position of each isometric muscle strength and movement of the cervical spine were statistically significant( P ＜0.05).Conclusions The tailored cervical pillow can promote the neck muscle balance of patients with cervical spondylosis,strengthen the stability of cervical spine and improve symptoms,which is one of value auxiliary treatment for cervical spondylosis. Key words: Cervical spondylosis; Tailored cervical pillow; Neck muscles; Balance

Trauma patients and cervical spine protection in critical care: the impact of a spinal checklist on clinical care and documentation

In October 2010 a specific online proforma for cervical spine (C-spine) assessment in the context of trauma was introduced in critical care in a large UK teaching hospital. The aim of this study is to assess the impact of the Metavision Spinal Checklist (MSC) on clinical care and documentation. Prior to October 2010, the documentation of C-spine status on admission to critical care was incomplete or unclear in over 40% of these patients.

Brain death after Concorde positioning for supracerebellar-infratentorial approach: Unanswered questions and lessons learned

Brain death after Concorde positioning for supracerebellar-infratentorial approach: Unanswered questions and lessons learned

Radiological cervical spine involvement in polyarticular idiopathic juvenile arthritis

erosions of the odontoid process (34%) and atlanto-axial impaction (20%). Apophyseal joint ankylosis (AJA) was rare (10%) but involvement of the posterior cervical spine (AJA and apophyseal joint arthritis) was more frequent (42%). Presence of radiographic cervical lesions was correlated in univariate analysis with a more severe disease phenotype: more erosive disease (hand and feet), higher number of biotherapies per patient (respectively 1.4±1.3 vs 0.5±0.5, p=0.003), and higher frequency of surgery (p=0.03, OR 7.74[0.92-65]) but not with RF status. Multivariate analysis confirmed only the association with the higher number of biotherapies per patients (p=0.04). 50% of pJIA with radiographic abnormalities had no clinical symptoms. In pJIA sub-group with cervical symptoms (n=24), patients needed more DMARDs and biotherapies per patient. Finally, comparison between pJIA and RA for radiographic findings showed only differences for two structural features: hypotrophy of vertebrae (24% vs 7%) and AJA (10% vs 0%). Conclusion Structural cervical spine involvement is a frequent manifestation in pJIA followed at adulthood and is correlated with a more severe disease. Radiologic assessment of cervical spine should be done systematically at onset and regularly during the course of the disease regardless of clinical symptoms. Cervical symptoms may be considered as a warning signal revealing presence of AJA.

Cervical Spine Clearance: A Review and Understanding of the Concepts

Cervical spine injury is relatively rare, occurring in only 2% to 3% of patients with blunt trauma who undergo imaging studies. However, timely and accurate recognition of cervical spine injury is essential for the optimal management of patients with blunt trauma as subsequent morbidity includes prolonged immobilization. Evaluation of cervical spine injuries should begin in the emergency department and involves a combination of pediatric, trauma, orthopedic, and neurosurgeons for definitive management. Knowing which patients are at highest risk for injuries will undoubtedly influence decisions on how aggressively to pursue a potential cervical spine injury and can be achieved by establishing a multidisciplinary team approach that provides cervical spine immobilization, assessment, and clearance. Implementation of such guidelines will decrease time for cervical spine clearance and incidence of missed injuries. In this article different aspects of cervical spine injuries and cervical spine clearance protocols are reviewed.

The impact of selective neck dissection on shoulder and cervical spine movements

Objective To investigate the deficits in function following a function-preserving neck dissection by comparing operative versus non-operative sides for cervical spine and shoulder movements in combination with patient self-completed questionnaires. Participants A consecutive cohort of 63 outpatients following levels I–III unilateral selective neck dissection were approached and all agreed to participate in the study. Methods Clinical examination included assessment of shoulder, shoulder girdle and cervical spine ranges of movement, measured by goniometry, tape measure and a cervical measurement system. Patient self-completed questionnaires included the University of Washington quality of life questionnaire (UW-QoL), the neck dissection impairment index and the shoulder disability questionnaire. Results Following unilateral selective neck dissection there was significant loss of shoulder flexion and abduction in the operated side compared to the non-operated side but not in regard to the other cervical spine and shoulder measurements. The loss of shoulder flexion averaged 9° (95% confidence interval: 3–14°) and the loss of shoulder abduction averaged 8° (95% confidence interval: 2–14°). The UW-QoL shoulder domain clearly identified patients with poor cervical spine and shoulder function. Conclusion This study emphasizes the problems patients encounter even with a function-preserving neck dissection. The UW-QoL questionnaire can aid physiotherapists to screen patients needing early intervention and further assessments.

What Defines a Distracting Injury in Cervical Spine Assessment?

The National Emergency X-Radiography Utilization Study defined five criteria for obtaining cervical spine radiographic investigations in blunt trauma patients. Distracting injury was given as the indication for more than 30% of all x-ray studies ordered. The hypothesis of this study was that upper and lower torso injuries would have different effects on clinical cervical spine assessment. This is a single-center, prospective, observational study of admitted, alert, adult blunt-trauma patients. All patients underwent cervical spine plain-film radiography. Data were collected on all injuries, physical examination findings, narcotic administration, and radiograph results. Patients with upper and lower torso injuries were compared in their ability complain of pain or midline tenderness relative to a cervical spine fracture. In all, 406 patients participated. All patients received narcotic analgesics before examination. Forty patients (9.9%) had cervical spine fractures, of whom seven had a nontender neck examination. All seven patients with a nontender cervical spine and a neck fracture had at least one upper torso injury. None of the 99 patients with injuries isolated to the lower torso and a nontender neck had a cervical spine fracture (p < 0.05). The frequency of cervical spine fracture among patients with cervical spine tenderness was 19.8% (n = 33). The National Emergency X-Radiography Utilization Study definition of a distracting injury may be narrowed. Upper torso injuries may be sufficiently painful to distract from a reliable cervical spine examination. Patients may detect spine tenderness in the presence of isolated painful lower torso injuries. Patients with spine tenderness warrant imaging.

Predicting Short Term Response and Non-Response to Neck Strengthening Exercise for Chronic Neck Pain

AbstractSummary of Background Data. People with chronic neck pain respond variably to exercise therapy. The likely success of exercise for chronic neck pain cannot be predicted.Study Design. This prospective study tested the relationship between patient characteristics assessed prior to intervention and response to an exercise program for chronic neck pain.Objectives. To investigate whether responders differed from non-responders with respect to presenting characteristics.Method. Data were collected on 336 consecutive patients receiving physiotherapy for chronic neck pain. Subject age, sex, duration of symptoms, compensation status, Neck Disability Index (NDI) item and total scores, cervical spine range of movement, and isometric strength were assessed prior to treatment. Response to therapy was defined as a change of 14/100 or more NDI points. Subjects received a progressive, concentric/eccentric, strengthening program using computerized equipment designed for cervical spine assessment and rehabilitation...

Cervical Spine Assessment in the Unconscious Trauma Patient: A Major Trauma Service???s Experience with Passive Flexion-Extension Radiography

There is no consensus on the most appropriate method of cervical spine assessment in unconscious trauma patients. Passive flexion-extension imaging is one option for further investigating unconscious patients whose plain cervical radiographs are normal. This study examines the usefulness of this passive imaging in investigating for occult cervical injury. All unconscious patients admitted to The Alfred Trauma Intensive Care Unit over 1 year (January 1-December 31, 1998), who could not be clinically assessed within 48 hours in regard to their cervical spine, were identified. Results of passive flexion-extension radiography were compared with final injury status and clinical outcome as determined by retrospective review of the imaging reports, radiographic films, and case notes. One hundred twenty-three patients with normal three-view plain radiographs proceeded to passive functional investigation. These were false-negative in four of the seven patients with cervical spine injuries at presentation. No patients suffered any adverse neurologic events from their delayed diagnoses or from the flexion-extension procedure. Passive flexion-extension imaging has inadequate sensitivity for detecting occult cervical spine injuries. Although no patients suffered adverse neurologic complications, the potential for devastating consequences from missed cervical injury has resulted in the removal of passive flexion-extension imaging from the screening protocol.

Predicting Short-Term Response and Non-Response to Neck Strengthening Exercise for Chronic Neck Pain

Summary of Background Data. People with chronic neck pain respond variably to exercise therapy. The likely success of exercise for chronic neck pain cannot be predicted.Study Design. This prospective study tested the relationship between patient characteristics assessed prior to intervention and response to an exercise program for chronic neck pain.Objectives. To investigate whether responders differed from non-responders with respect to presenting characteristics.Method. Data were collected on 336 consecutive patients receiving physiotherapy for chronic neck pain. Subject age, sex, duration of symptoms, compensation status, Neck Disability Index (NDI) item and total scores, cervical spine range of movement, and isometric strength were assessed prior to treatment. Response to therapy was defined as a change of 14/100 or more NDI points. Subjects received a progressive, concentric/eccentric, strengthening program using computerized equipment designed for cervical spine assessment and rehabilitation. Logistic regression formulae for predicting outcome at the completion of the program were developed on one sample (n = 122) data and tested on another (n = 214).Results. In the first sample, NDI scores and item responses predicted response or non-response with approximately 70% accuracy. When tested on the second sample, a prediction model using NDI item scores predicted responders (positive predictive value 56%) and non-responders (negative predictive value 74%) with considerable loss of responder prediction accuracy. Participants with low initial NDI scores (higher functional ability) appeared to benefit less from the exercise program.Conclusions. Functionally able patients may benefit less from exercise for chronic neck pain than those with greater functional limitations.

Have ATLS and national transfer guidelines improved the quality of resuscitation and transfer of head-injured patients?: A prospective survey from a Regional Neurosurgical Unit

High-quality resuscitation and care during transfer of head-injured patients is essential to prevent secondary brain injury. We have prospectively assessed the standard of resuscitation in 50 consecutive head-injured patients transferred to our unit, and compared our findings with previous studies performed before the advanced trauma life support course (ATLS) had become widespread and national guidelines on the transfer of head injuries had been produced by the Association of Anaesthetists of Great Britain and Ireland (AAGBI). Delays in transfer, management of the airway, adequate cervical spine assessment, hypoxia (P aO 2 <13 kPa), hypotension (systolic BP <90 mmHg), missed injuries and the experience of the medical escort were compared against the standards laid out in ATLS and AAGBI Guidelines. The mean, unavoidable delay from arrival at the local accident and emergency unit to arrival was 7.4±1.9 h (mean±95%CI) with most of the delay being prior to initial referral. Two patients arrived with an unsecured airway with a GCS=8/15; 26 had inadequate cervical spine imaging; 7 patients arrived hypoxic and 2 patients arrived hypotensive; most of these insults occurred during the transfer. Forty-six percent of medical escorts did not fulfil the minimum standard of experience. ATLS and AAGBI guidelines have provided only modest improvements in patient care at the expense of long delays in transfer. The incidence of hypoxia and hypotension remains unacceptably high.

A multidisciplinary approach to the development of a cervical spine clearance protocol: Process, rationale, and initial results

Background/Purpose: Assessment of potential spine injuries is inconsistent and controversial. Subsequent morbidity includes prolonged immobilization and missed injuries. To address these issues, a multidisciplinary team was organized to design a cervical spine management/clearance pathway. The process, algorithm, and initial results are described. Methods: Team members consisted of pediatric surgeons, orthopedic surgeons, neurosurgeons, emergency room physicians, and trauma nurse practitioners. Nationwide standards, guidelines, and experiences across disciplines were reviewed, and a consensus pathway evolved for cervical spine clearance in children 8 years and younger. A short-term retrospective review (5 months) was performed to assess initial performance. Time required for clearance, number and type of imaging studies, and number of missed injuries were compared between a group of patients before (n = 71) and after (n = 56) the implementation of the pathway. Results: Strict guidelines for cervical spine immobilization and clearance criteria were defined. After implementation of this pathway, time required for cervical clearance in nonintubated children decreased (before, 12.3 ± 1.5 v after, 7.5 ± 0.9 hours; P =.014). A clear trend toward earlier clearance in intubated patients existed (before [n = 6], 40.0 ± 16.8 v after [n = 6], 19.4 ± 8.1 hours; P =.10); there need to be larger numbers to determine statistical significance. The 2 study groups were similar in age; mechanism of injury; Glasgow coma scale score; and number of plain x-rays, computed tomography scans, and magnetic resonance imaging studies obtained. Neither group had missed injuries. Conclusions: standards for cervical spine immobilization, assessment, and clearance. Implementation of such guidelines decreased time for cervical spine clearance, and ongoing analysis of sensitivity is encouraging. J Pediatr Surg 38:358-362. Copyright 2003, Elsevier Science (USA). All rights reserved.

MOVEMENT BEHAVIOUR IN NON-SPECIFIC NECK PAIN

The purpose of this study was to investigate neck movements in all anatomical planes and to compare between normal and pathological cases. For the quantitative assessment of cervical spine kinematics a 3D ultrasonic measurement device operating at 30Hz has been used. Six-teen patients complaining of chronic (> 3 month) non-specific neck pain and 18 age and sex matched healthy controls participated in the study. Kinematic data obtained from two marker clusters mounted on the head and trunk were used to describe relative movements of the head. The standardized measurement protocol was designed to collect 10 repetitions of maximum flexion/extension, axial rotation and lateral flexion movements per subject at a self-imposed, comfortable speed. All data were low-pass smoothed (8Hz cut-off) and normalized to percent movement cycle (0–100%). Maximum oscillation angles (degrees) of the various movements were calculated for amplitude analysis. Coefficients of variation (CV) have been computed to assess the intra-subject variability in the oscillation angles over time. Mann-Whitney U-tests were calculated for differences of mean maximum angles and variability measures. Cross-correlation values demonstrated almost similar movement patterns between cervical spine patients and unimpaired controls (r = 0.811 - 0.983; p < 0.01). Data analysis showed significant (p < 0.05) reductions in the mobility of the cervical spine ([degree] Ext 38.8 ± 20.5 vs. 55.6 ± 8.8; Flx 43.8 ± 16.8 vs. 67.2 ± 10.2; Lat 28.3 ± 14.1 vs. 35.6 ± 6.8; Rot 56.6 ± 19.2 vs. 68.9 ± 6.8) and increased movement variability in the patient group ([CV%] Ext 19.7 ± 1.3 vs. 13.9 ± 11.1; Flx 19.8 ± 11.2 vs. 13.9 ± 11.1; Lat 18.1 ± 9.6 vs. 11.3 ± 3.6; Rot 20.7 ± 12.7 vs. 10.3 ± 3.1). Thus it appeared from the relative movement data of the head that cervical patients demonstrate an increasingly restricted but more variable movement pattern.

The role of helical CT in the assessment of cervical spine injuries.

The role of helical CT in the assessment of cervical spine injuries.D B Nuñez, Jr and R M QuencerAudio Available | Share

A continuing role for pre-operative cervical spine radiography in rheumatoid arthritis?

Pre-operative cervical spine radiographs are routinely requested for patients with rheumatoid disease, prior to elective orthopaedic surgery, but no guidelines exist governing the indications for this investigation. One hundred and twenty-eight such patients were reviewed retrospectively. No patient had signs or symptoms attributable to cervical cord compression. The incidence of unsuspected C1/2 subluxation was 5.5%, and as many as 37% of examinations could have been avoided by assessing previous radiographs. The apparent lack of effect on subsequent anaesthetic management was noticeable. Techniques that do not require hyperextension of the neck were employed in 12 of 19 patients with craniocervical instability and included the laryngeal mask airway, face mask or spinal anaesthesia. However, similar variations in anaesthetic technique were observed in patients without cranio-cervical instability. It is concluded that pre-operative cervical spine assessment in asymptomatic patients with rheumatoid disease is unnecessary, prior to elective orthopaedic surgery.

Clearing the cervical spine in multiple trauma victims: A time-effective protocol using helical computed tomography

This study was performed to evaluate helical computed tomography (HCT) as the primary method of initial cervical spine assessment in multiple trauma victims. Prospective evaluation of the cervical spine using HCT and plain film radiography (PFR) was performed in 800 patients with suspected multisystem injuries. With HCT, an average of 32 slices were obtained at 5-mm intervals from the base of the skull to T1 using helical acquisition and a bone algorithm. HCT was performed following cross-table lateral radiographs of the cervical spine in all patients. We compared HCT and PFR for detection of abnormalities and duration of examination and also compared HCT with conventional CT in a subset of patients (N=20) for image quality/lesion detectability. Sixty-eight fractures were identified in 46 patients. HCT prospectively identified 67 fractures (98.5%), and plain films demonstrated 29 fractures (43%). No difference in image quality/lesion detectability was encountered when comparing HCT to conventional CT. HCT of the cervical spine could be completed in 4.5 minutes and added an average of only 8 minutes to the stay of the patient in the CT room. During the time of the study, the overall patient disposition time from the trauma resuscitation area was reduced from 6.5 to 4.5 hours. Rapid and accurate evaluation of the cervical spine is possible with HCT and is recommended as part of the initial imaging protocol in multiple trauma patients.